Blood pressure targets

There is strong evidence that lower than usual targets are beneficial in renal diseases, but especially in those associated with significant proteinuria. Any limits set are arbitrary, but for example, the current SIGN and NICE guideline levels are:

The previous UK CKD guidelines and some US guidance recommended slightly lower targets, and some nephrologists favour these:

130/80 for patients with diabetes mellitus and microalbuminuria (but note that diabetics with microalbuminuria benefit from ACE inhibitors at all levels of blood pressure, including normal levels)

130/80 for non-diabetic patients with chronic renal failure

125/75 for those with chronic renal failure of any aetiology if they also have proteinuria >1g/d (Prot/Creat ratio > 100mglmmol), unless this lower target is contraindicated

ACE inhibitors are proven to be particularly effective at protecting renal function in patients with proteinuria. A2R antagonists are likely to be equally effective. Non-dihydropyridine calcium antagonists (verapamil, diltiazem) have some theoretical (not proven) advantage if patients cannot tolerate ACEI or A2R blockade.

In individual patients

Targets should be individualised, as patients have different circumstances. Benefits from blood pressure reduction do not seem to have age limits, but younger patients might be treated more aggressively as their lifetime risk of end organ damage is greater.

It is sometimes useful to consider average blood pressure at different ages - although it must be noted that there is no evidence to support using these as therapeutic targets. Figures are from Scotland, 1998.